Opening new trauma center no easy task

Jennifer Knight

Thursday, Aug. 21, 2003 | 11:08 a.m.

Sunrise Hospital and Medical Center may want to open a trauma center, but it faces an uphill battle finding the medical residents and specialists to staff it, members of the medical community said Wednesday.

Sunrise chief executive Allan Stipe said this week his hospital is interested in opening the area's second trauma center -- just a few miles from University Medical Center.

The hospital's interest in opening the area's second trauma center would require around-the-clock physicians with specialties in trauma surgery, orthopedic surgery, anesthesia, neurology and a number of other disciplines. It would also require a medical residency program, which right now exists only at the UMC.

Between staffing the center and setting up such a program, physicians and medical officials say Sunrise Hospital's proposed trauma center could prove difficult and costly.

"Right now, it's very difficult to attract those kinds of physicians to the Las Vegas area because of the continuing costs of malpractice insurance and managed care compensation," said Larry Matheis, executive director of the Nevada State Medical Association.

Matheis said given the high-risk nature of being a trauma physician, skyrocketing malpractice insurance rates have driven many specialists out of state while at the same time preventing others from coming here.

High malpractice insurance rates led to the closure of UMC's trauma center last year because doctors could no longer afford it. The center closed for 10 days because UMC did not have the required number of specialists to staff it.

A special legislative session was aimed at solving the problem by making capping emergency room and trauma physician's liability level at $50,000 per incident, easing the burden for hospitals with trauma centers.

Mike Walsh, UMC chief executive, said even after the medical malpractice legislation his hospital has trouble keeping its specialists.

"Creating a trauma center isn't exactly going to double our specialists," Walsh said. "They (Sunrise) are probably going to have to approach some of our specialists and ask if they want to split their time with us. That is probably going to, in the short term, create a negative effect on the trauma system as a whole."

But if malpractice rates prevent too many specialists from coming to the state, Sunrise Hospital may have to pull personnel from its on-staff physicians to man the trauma center. According to one doctor, that may not be a popular move.

"If you make a trauma center at Sunrise, those doctors will migrate elsewhere," said Jonathan Camp, a pediatric orthopedic surgeon affiliated with the hospital. "A trauma center has a certain unpredictability to it."

UMC's trauma center is designated as a level-one center, which is the top level a hospital can achieve, allowing it to handle any level of trauma.

Walsh questioned whether there was a need for another center. He said that over the last five years the population has grown about 24 percent, and the number of traumas has grown only 8 percent.

"The assumption that Sunrise is making is that as the population grows, the number of traumas is growing in parallel," he said. "That's just not true."

Walsh said he isn't against another trauma center but said "people in the community should get together and decide, based on where the traumas are coming from, where it should be placed."

Stipe told the Sun earlier this week that his staff was "seriously pursuing" the idea of opening a trauma center. He said the city could use another center and said his facility is logically the next hospital to open a trauma center.

On Wednesday Sunrise officials would not give further details.

"We're in the very early stages of considering a trauma center," said Cheryl Smith, Sunrise Hospital spokeswoman. "I think it's very premature to get into specific details." Aside from staffing issues, in receiving the designation of a level-one trauma center Sunrise would need to establish a surgical residency program, which right now exists between the University of Nevada Medical School and the University Medical Center.

"I think (a residency program) is actually part of the mission of a level one trauma unit," said Michael Harter, vice dean of UNR's medical school.

Harter said that the agreement between UNR and UMC allows Medicaid to pay for 19 surgical residents. Since that agreement does not allow any subsidized surgical slots for Sunrise Hospital, the hospital would have to pay for its residents out-of-pocket.

Harter said Sunrise would also have to find a program from out of state that is willing to send residents to Las Vegas.

"If Sunrise were to have residents from another program, they probably would have to pay the full cost of those residents and that's not cheap," Harter said.